Pre-treatment with dual antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention

• Published in: Internal medicine journal 2015-10, Vol.45 (10), p.1032-1037
• Main Authors: Yudi, M. B., Eccleston, D., Andrianopoulos, N., Farouque, O., Duffy, S. J., Brennan, A., Reid, C., Clark, D. J., Ajani, A. E.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - surgery; Aged; Aspirin - therapeutic use; Australia; clopidogrel; Female; Hemorrhage - etiology; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; NSTEACS; PCI; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Postoperative Complications; pre-treatment; Registries; Ticlopidine - administration & dosage; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Treatment Outcome
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.12818

Background Although dual antiplatelet therapy is the standard of care in non‐ST‐segment elevation acute coronary syndromes (NSTEACS), it remains unclear when a second antiplatelet agent should be initiated. We sought to assess the safety and efficacy of pre‐treatment with clopidogrel in patients with NSTEACS undergoing percutaneous coronary intervention (PCI). Methods We analysed baseline clinical and procedural characteristics of 6817 patients with NSTEACS who underwent PCI from the Melbourne Interventional Group registry from 2005 to 2012. Patients were included in the pre‐treatment group if clopidogrel was administered prior to cardiac catheterisation. We assessed 30‐day mortality, myocardial infarction (MI) and major adverse cardiovascular events. The safety endpoint was in‐hospital bleeding. Results Of the 6817 patients, only 2951 (43%) received pre‐treatment with clopidogrel. Patients in the pre‐treatment group were more likely to present with unstable angina (70.8% vs 68.2%, P = 0.02) and have a history of MI (35.6% vs 23.6%, P < 0.01) but were less likely to have PCI within 24 h of admission (17.2% vs 25.2%, P < 0.01). There was no difference between the groups in 30‐day mortality (0.9% vs 1.4%, P = 0.06), MI (2.0% vs 2.2%, P = 0.52) or major adverse cardiovascular event (3.7% vs 4.2%, P = 0.25). There was no difference in bleeding complications (1.9% vs 1.9%, P = 0.94). Conclusions Pre‐treatment with dual antiplatelet therapy in NSTEACS is not routine clinical practice in Australia. Pre‐treatment appears safe but is not associated with improved short‐term clinical outcomes.